If you have a multiple pregnancy or your baby’s growth is slowing down you will be offered extra monitoring to check the growth and wellbeing of your baby. The hospital should have a special care baby unit (SCBU) and ideally a neonatal intensive care unit (NICU).
Twin pregnancies often deliver around 37 weeks and triplets often deliver even earlier, around 33 weeks.The extra monitoring involves growth scans usually at 2 – 3 week intervals, checks on the amount of fluid around the baby using ultrasound and monitoring the pattern of the fetal heart beat. All these factors are used by the doctors to decide the safest time for delivery.
If you begin having contractions prematurely the doctors will try to determine the cause so that they can decide if it is safe to give you medication (tocolytic drugs) to stop the contractions. If there is bleeding or any sign of infection, tocolytics will not be given.
If it is safe to stop the contractions, tocolytics will be given to allow time for administration of 2 steroid injections.
What are steroids used for in threatened premature labour?
A premature baby has immature lungs. Steroid injections are used to help mature a premature baby’s lungs so they produce surfactant. Surfactant allows the lung tissue to inflate correctly in the baby’s lung so that it breathes properly after delivery. Without surfactant it is very hard to get air into the baby’s lung.
Steroids are ideally given at least 48 hours before an expected premature delivery so that they have begun to take effect. This may not be possible if the onset of labour is sudden and rapid.
What are the long term effects of prematurity?
This depends greatly on the degree of prematurity. A baby born at only 24 weeks may have many more problems than a baby born at 36 weeks.The state of the baby’s lungs is the primary factor influencing the management of premature babies. If the lungs are working well, the baby’s progress is usually good. Lung problems can affect the baby’s progress and prolong the need for specialist care and treatment.Disability risk is related to the degree of prematurity and to any other underlying factors such as the presence of congenital abnormality eg cardiac structural problems, gut problems etc
Development of babies born prematurely
Paediatricians use the expected date of delivery rather than the real date of birth as a more realistic indicator of their development.Premature babies are regularly screened at intervals for potential disability and neurodevelopmental problems. Babies will undergo standard neurodevelopment screening. They may have video assessment to monitor the development of their motor skills. Many low-birthweight babies including premature babies are included in longitudinal studies to assess their development and offer early intervention if needed.
Growth in babies born prematurely
Premature babies are often smaller than their full-term peers. Their weight gain can lag behind so it takes longer to catch up to their ideal centile for weight and height.Your baby’s medical team (nurses, doctors, health visitors) will concentrate on achieving steady growth in terms of weight, head circumference, and length.
Growing steadily is more important that moving to a higher centile for weight and height.
The video below gives some breastfeeding tips.